Qualified Domestic Relations Order - State Of Louisiana District Court Page 3

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Pursuant to LSA-R.S. § 11:2178(J), if Participant has sufficient years of service to
retire but has not yet retired at the time of Participant’s death, and Participant’s death
is not in the line of duty, and Participant is survived by a spouse with whom
Participant is living at the time of his/her death, then the “Option 2" benefit will be
paid out as provided by law and Alternate Payee shall receive as a benefit Alternate
Payee’s percentage as determined under paragraph 4 above of the Option 2 benefit
until Alternate Payee’s death or the death of Participant’s surviving spouse,
whichever occurs first.
If Participant does not have sufficient years of service to retire and Participant’s death
is not in the line of duty, then Alternate Payee shall have an interest in the refund of
Participant’s contributions as set forth in paragraph 4 above.
Pursuant to LSA-R.S. § 11:2178(I), Participant shall have the right to elect to receive
Participant’s retirement allowance according to the options set forth in that section.
Alternate Payee shall not be a spouse or surviving spouse for purposes of giving or
withholding consent to any retirement option elected by Participant. Alternate Payee
shall receive Alternate Payee’s percentage as determined under paragraph 4 of all
distributions made by the Fund on account of Participant’s service until Alternate
Payee’s death, or, if sooner, until the later of the death of Participant and the spouse
to whom Participant was married at the time of Participant’s retirement.
Alternate Payee shall not be considered a surviving spouse of the Participant for any
purpose.
6.
No Increase in Payments.
No election by Participant and no action or failure to act by Alternate Payee shall
have the effect of increasing the amount payable by the Fund on account of
Participant’s service as authorized by the laws of the State of Louisiana.
The percentage of Participant’s total benefit which is set aside for Alternate Payee
shall not be construed to provide for the payment to Alternate Payee of any amounts
which were previously awarded or may subsequently be awarded to any previous or
future spouse or alternate payee of Participant’s retirement benefit.
Alternate Payee shall receive Alternate Payee’s percentage as computed above by
separate payment made payable to the account of Alternate Payee. Under no
circumstances will the Fund pay the Alternate Payee’s share by joint check to any
other person.
7.
Further Information. The obligation of the Fund to make payments to Alternate
Payee or Participant is conditioned on the furnishing of such information to the Fund
by Alternate Payee and Participant as the Fund may reasonably require, including but
not limited to such information as may be required to complete tax reporting forms.
8.
Tax Treatment of Distributions. All distributions made pursuant to this order shall
be reported as income taxable to the recipients thereof for federal income tax
purposes.
9.
Continued Jurisdiction. This court shall retain jurisdiction over this Order to the
extent required to entertain modifications thereto in order to maintain its tax qualified
status and to enforce the provisions hereof.
_______________________, Louisiana, this ___ day of ____________, _____.
__________________________________
J U D G E
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